Unsealed Court Documents Show That Admiral Rachel Levine Pressured WPATH To Remove Age Guidelines From The Latest Standards Of Care

A head-on collision between science and politics

Helen Lewis and I are doing a live event in London on August 3. Tickets here!

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When the World Professional Association for Transgender Health’s Standards of Care Version 8 was released in September 2022, a very strange thing happened: WPATH removed references to minimum age requirements for various medical interventions, describing the change as a “correction” in a notice that now reads, weirdly: “This correction notice has been removed as it referred to a previous version of the article, which was published in error.” Whatever happened, exactly, it’s clear that until late in the game the document did have age minimums until, suddenly, it did not.

The SoC 8 was supposed to have been created via something called the Delphi process. As the document itself explains: “Consensus on the final recommendations was attained using the Delphi process that included all members of the guidelines committee and required that recommendation statements were approved by at least 75% of members.” Suffice it to say that making a sudden, major change so late in the game calls into question whether that process was fully adhered to.

Thanks to a rather remarkable document just unsealed as part of Boe v. Marshall, one of the many American lawsuits over youth gender medicine, we now have a potential explanation for why the age guidelines were removed: direct pressure from assistant secretary for health of the Department of Health and Human Services Admiral Rachel Levine (who is a trans woman herself) and the American Academy of Pediatrics.

The document is titled “Appendix A To Supplemental Expert Report Of James Cantor, Ph.D. In it Cantor, a Canadian sex researcher, critic of youth gender medicine, and frequent expert witness on behalf of those attempting to ban or or restrict it (including in this case), claims that “Assistant Secretary for Health Dr. Rachel Levine strongly pressured WPATH leadership to rush the development and issuance of SOC-8, in order to assist with Administration political strategy.”

He backs this claim up with the following internal communications from WPATH members involved with the creation of the SoC 8 (here and elsewhere in the document, the names of the people who wrote the words in question are redacted):

I have just spoken to Admiral Levine today, who—as always is extremelysupportive of the SOC 8, but also very eager for its release—so to ensureintegration in the US health policies of the Biden government. So, let’s crack onwith the job!!! 

I am meeting with Rachel Levine and her team next week, as the US Department of Health is very keen to bring the trans health agenda forward.

The failure of WPATH to be ready with SOC 8 is proving a barrier to optimal policy progress and she [Dr. Levine] was eager to learn when SOC 8 might be published. 

[T]his should be taken as a charge from the United States government to do what is required to complete the project immediately. 

More worryingly, Cantor charges that “Assistant Secretary Levine also attempted to and did influence the substantive content of SOC-8, based on political goals rather than science. Specifically, Assistant Secretary Levine, though [sic] a staff member, pressured WPATH to remove recommended minimum ages for medical transition treatments from SOC-8.”

Here, too, he has evidence from anonymized emails written by those involved in the SoC 8:

Sarah Boateng, who is Adm. Levine’s chief of staff [said the] biggest concern is the section below in the Adolescent Chapter that lists specific minimum ages for treatment, she is confident, based on the rhetoric she is hearing in DC, and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out and perhaps an adjunct document could be created that is published or distributed in a way that is less visible than the SOC8, is the way to go. 

The issue of ages and treatment has been quite controversial (mainly for surgery) and it has come up again. We sent the document to Admiral Levine. . . She like [sic] the SOC-8 very much but she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too. Apparently the situation in the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them. We have the WPATH executive committee in this meeting and we explained to her that we could not just remove them at this stage. 

[W]e heard your [Dr. Levine’s] comments regarding the minimal age criteria for transgender healthcare adolescents; the potential negative outcome of these minimal ages as recommendations in the US [. . . ] Consequently, we have changes to the SOC 8 in this respect. Given that the recommendations for minimal ages for the various gender affirming medical and surgical intervention are consensus-based, we could not remove them from the document. Therefore, we have made changes as to how the minimal ages are presented in the documents. [Note: “your” may well refer to an aide of Levine’s rather than the Secretary herself, though it’s unclear.] 

Cantor also includes emails from SoC 8 contributors expressing surprise at the sudden change, including this one making. . . well, the same point everyone else made after news of the late-stage “correction” broke:

I don’t see how we can simply remove something that important from the document—without going through a Delphi—at this final stage of the game [. . . ] I realize that those in favor of the bans are going to go right to the age criteria and ignore the fact that we actually strengthened the strictness of the criteria to help clinicians better discern appropriate surgical candidates from those who are inappropriate [. . . ] It’s all about messaging and marketing. 

I’m actually crashing on a different but related freelance story at the moment. Check out Leor Sapir’s Twitter timeline for more details about this and another just-unsealed document. Next week, when I’ve caught my breath, I’ll write a little bit more about this as well as yet another damning claim Cantor makes, that the American Academy of Pediatrics “issued an ultimatum to WPATH: Should WPATH not delete the age minimums, AAP would not only withhold endorsement of SOC-8, but would publicly oppose the document.” 

But I wanted to at least get this short piece up, because the Levine angle is important and alarming. It demonstrates an indisputable conflict between how WPATH has portrayed the SoC 8 — as a document steeped in evidence and careful deliberation on the part of experts — and how the guidelines were actually formulated.

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Questions? Comments? Demands that I change my policies surrounding the age at which readers are allowed access to this newsletter? I’m at singalminded@gmail.com or on Twitter at @jessesingal. 

Image: WASHINGTON, DC - OCTOBER 21: (L-R) Jesse M. Ehrenfeld, MD, MPH, President of the American Medical Association; Admiral Rachel L. Levine, MD, the 17th Assistant Secretary for Health (ASH) for the U.S. Department of Health and Human Services; and Charlotte Clymer, writer, transgender activist, and military veteran speak on stage during Learning With Love: The 2023 PFLAG National Convention, four days of educating, lobbying, networking, and leading with love, taking place October 19-22, 2023 in Washington, DC. (Photo by Paul Morigi/Getty Images for PFLAG National)