President Biden’s pick for assistant secretary of Health and Human Services, a transgender physician from Pennsylvania, has advocated the chemical castration of children questioning their sexuality for nearly a decade.
Rachel Levine, who would make history as the first transgender official to be confirmed by the Senate, has long held several controversial beliefs on the topic of pediatric medicine — some of which rose to the surface during her confirmation hearing on Thursday.
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Although most questions asked of her focused on how she would facilitate the distribution of COVID-19 vaccines and direct policies to avoid future health catastrophes, Sen. Rand Paul, a Kentucky Republican and medical doctor, grilled Levine on her past statements promoting hormonal therapy for minors who say they’re transgender.
“Like surgical mutilation, hormonal interruption of puberty can permanently alter and prevent secondary sexual characteristics,” Paul said, after comparing transgender surgeries to genital mutilation. “The American College of Pediatricians reports that 80% to 95% of pre-puberty children with gender dysphoria will experience resolution by late adolescence if not exposed to medical intervention and social affirmation. Dr. Levine, do you believe minors are capable of making such a life-changing decision of changing one’s sex?”
Levine, who previously served as secretary of the Pennsylvania Department of Health, dodged Paul’s question and called the topic a “very complex and nuanced field” and offered to meet with the senator in private to discuss the matter further.
Paul’s remarks were quickly labeled as transphobic by many in the media and drew outrage from activists. Despite that criticism, the exchange highlighted the chasm between tens of millions of people who resist the idea that gender or biological sex is fluid and left-wing proponents who say prescription puberty blockers for children help remedy an identity crisis many suffer from.
“Sen. Rand Paul’s comments were wrong and propaganda. Transition care, including puberty blockers, are life-saving and often necessary. They are safe and effective,” National Women’s Law Center spokeswoman Gillian Branstetter told the Washington Examiner. “There’s a targeted misinformation campaign from right-wing groups. Sen. Paul is smart and knows better.”
Activists such as Branstetter point to myriad studies allegedly showing that hormonal therapies for children who believe they are transgender lead to lower suicide rates and improved mental health. The Center for Disease Control released a survey in 2019 finding that “transgender students were more likely than were cisgender students to report violence victimization, substance use, and suicide risk, and, although generally more likely to report sexual risk behaviors, were also more likely to report having been tested for human immunodeficiency virus.”
Levine strongly concurs with these conclusions from some in the medical community. In several speeches over the years, she touted breakthroughs in cross-sex hormonal therapies and celebrated a new era where children were no longer restricted by the circumstances of their birth.
“The first phase at the young adolescent age is to give what they call a pubertal blocker, medicine to block the progression, low doses that you gradually increase,” Levine said at a conference at Franklin & Marshall College in 2017. “The treatment supposedly ensures “that they never go through the wrong puberty. That way, for a transgender woman, male to female, their voice doesn’t drop, they don’t have hair. … For a transgender man, they don’t have breast development, they don’t have periods.”
During a 2012 appearance at the Keystone Conference in Pennsylvania, Levine hosted a workshop on “transgender medicine and hormone replacement therapy” for children. Her bio for the event said she “is pleased to accept any pediatric patients and patients in their teens and twenties for [transgender] medical care.”
Not all health experts agree with Levine’s conclusions. Moreover, some doctors warn that so-called gender-affirming therapy for minors carries significant, irreversible risks that often cause more harm than good.
Studies have shown that the use of the sex hormone oppressor Lupron for transgender therapy, something the Food and Drug Administration never cleared it for, can carry significant dangers for boys, such as obesity, bone issues, and a higher risk of testicular cancer. Critics of the practice point to research that found many children who experienced gender dysphoria, sometimes as high as 80%, no longer express feelings of wanting to change their gender after puberty.
“I think it’s an important conversation to have,” said Dr. Paul Hruz, an associate professor of pediatrics at the Washington University School of Medicine. “When it’s being discussed, people say there’s robust research [showing transgender therapy on children is harmless], that’s not a true statement. The research itself is not where it should be for the degree of this kind of intervention.
“Most of the recommendations being made are based upon low or very low-quality evidence,” he added. “Especially in the area of the puberty blockers, we have no long-term data. We’re having some emerging data on the adverse effects and data that leads to questions about risk and benefit.”
Some Republican-led states have begun proposing laws barring gender-affirming therapy on children altogether. A bill currently deliberated in Missouri would mean doctors who facilitate any attempt to change a child’s gender would lose their medical license. Parents who allow the treatment would also be referred to the state’s child welfare agency.
Left-wing groups such as the American Civil Liberties Union have vowed to fight back against any efforts to restrict access to the drugs, calling the ability to change one’s gender, at any age, a human rights violation.
The Biden administration appears prepared to back the views of Levine and others. On his first day in office, the president signed a bill forcing schools to allow transgender children to play on sports teams of the opposite sex.
“I would just say that the president’s belief is that trans rights are human rights, and that’s why he signed that executive order,” press secretary Jen Psaki said earlier this month. “In terms of the determinations by universities and colleges, I certainly defer to them.”
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But moving full steam ahead on what critics call an unscientific, if not completely ideological, medical treatment could potentially harm children in the future. The very availability of drugs such as Lupron, doctors like Hruz argue, means children aren’t making neutral decisions on whether they truly suffer from gender dysphoria.
“The biggest concerns are relative risk and benefit. It’s being portrayed as safe when there’s no evidence that we know that whatsoever. When you look at the actual data, these studies showing hormonal treatments supposedly lower suicide risk don’t show that all,” he said. “There’s many doctors who have reservations or concerns about what’s being put forward, and they’re being silenced. That’s really not good medicine. We need to be careful about that.”
