Rachel Levine does not support gender confirmation surgery for all children

Since being nominated for the post of assistant health secretary, Dr. Rachel Levine has faced repeated attacks focusing on her identity as a transgender woman. 

One of these attacks circulated on social media platforms in the form of a viral image, which features a picture of Levine photoshopped next to a group of prepubescent children. 

"Dr. Rachel Levine, US Assistant Secretary for Health, believes that all children should be allowed to select their gender and have access to government-funded sex reassignment surgery without parental notification or authorization," reads the text beside the image.

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.) 

In support of their claims, Levine’s critics have surfaced a 2017 lecture she gave at Franklin & Marshall College, where she described professional standards of care for transgender youth. They have also referenced a tweet in which Levine cited a study that found that access to puberty blockers decreases the likelihood of suicide and mental health problems for adolecents with gender dysphoria.

However, we could not find any instance where Levine advocated for children to receive government-funded gender confirmation surgery without parental consent. Performing genital surgery on prepubescent minors violates professional standards of transgender medicine. 

During her lecture at Franklin & Marshall, Levine described the standards of care for transgender patients laid out by professional organizations such as the World Professional Association for Transgender Health. Current U.S. health guidelines do not recommend surgical treatment for minors. 

At one point of the lecture, Levine explicitly notes that the guidelines do not recommend any form of medical treatment for children prior to puberty. "For prepubertal children (with gender dysphoria) there is no medical treatment," she says. "The idea would be to see a counselor or therapist who is supportive and has knowledge about these issues, to work with the parents." 

At another point of the lecture, Levine discusses standards of care for transgender youth, laying out a three-tiered protocol drawn up by professionals in transgender medicine. 

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Before doctors prescribe any physical interventions, the guidelines require patients to undergo counseling and psychological evaluation by a team of health professionals, including psychologists, pediatricians and endocrinologists. This process also allows kids to begin the process of socially transitioning to another gender by using different names and wearing different clothing. 

If a patient has begun to go through puberty and is determined to have experienced "persistent, well-documented gender dysphoria" for a long period of time, the youth becomes eligible to receive puberty blockers. These drugs suppress the release of testosterone and estrogen during puberty. The goal of this phase of treatment is to allow transgender youth more time to reflect on their decision. Different youth experience the onset of puberty at different ages, so the guidelines don’t provide a strict age threshold at which patients become eligible for the first stage of treatment. However, most studies of transgender youth have featured subjects at least 12 years old. 

If the youth completes this phase of treatment, doctors can slowly start off with interventions such as hormone therapy to masculinize or feminize the body. Some of these changes (such as the deepening of the voice caused by testosterone) are irreversible. Others may require reconstructive surgery to be reversed. Many hospitals, such as the Duke Health Center for Gender Care for Children and Adolescents, will only offer hormone replacement therapies for adolescents 16 or older. 

Genital surgery, the last phase of the process, is generally restricted to adults. The World Professional Association for Transgender Health guidelines state that genital surgery shouldn't be performed until the patient reaches the age of majority, which is at least 18 across the U.S. — and there are many other factors besides age that should also be considered.

"Genital surgery should not be carried out until (i) patients reach the legal age of majority to give consent for medical procedures in a given country, and (ii) patients have lived continuously for at least 12 months in the gender role that is congruent with their gender identity. The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention," the guidelines read. 

During her lecture, Levine noted that homeless youth could be eligible for an accelerated transition process. Since these youth lack parental support and are more likely to purchase dangerous black market hormones, she suggested that it might be necessary to skip the puberty-blocker phase of treatment and go straight to hormone therapy. However, at no point in the lecture did Levine state that homeless youth could be eligible for genital surgery before reaching the age of majority. 

Facebook posts said that Rachel Levine supports "government-funded sex reassignment surgery without parental notification or authorization" for all children.

There is no record of Levine supporting genital surgery for young children. In a lecture, Levine stated that "there is no medical treatment" for prepubescent children with gender dysphoria. 

Performing genital surgery on prepubescent children violates the standards of care laid out by professionals in transgender medicine. 

This claim is False.