Senator Rand Paul, R-Ky., Compared gender-affirmation surgery to “genital mutilation” during confirmation hearings on Thursday for Dr. Rachel Levine, appointed by President Joe Biden as assistant health secretary.
If approved, Levine will become the first openly transgender federal employee to be confirmed by the United States Senate.
Paul, a former ophthalmologist, was questioning Levine about transition-related care for transgender youth when he said that “genital mutilation is considered particularly flagrant because … it is almost always done on minors and is a violation of children’s rights. “
Wrongly claiming that Levine supports the “surgical destruction of a minor’s genitalia”, Paul asked Levine if she believed that minors are capable of “making a life-changing decision how to change sex?”
Levine, a pediatrician, responded that transgender medicine is “a very complex and nuanced field, with robust research and standards of care that have been developed,” and promised to discuss details if it is confirmed.
Paul continued his line of questioning, asking if she supports the government’s permission to override parental consent to give a child puberty blockers, cross-sex hormones and “breast and genital amputation surgery”. Levine gave a similar answer, prompting Paul to accuse her of running away from the question.
He further questioned criticism of the hydroxychloroquine prescription to treat Covid-19 by the same people who maintain hormones for transgender teenagers.
Dr. Colt Wasserman, a colleague at Physicians for Reproductive Health, which provides gender-based care for trans children, told NBC News that Paul’s questions and concerns “are not based on medical facts of any kind”.
Wasserman said that gender affirmation care is understood and supported by leading medical and medical associations “as a life affirmation practice that, through an informed consent process, patients, parents and their providers come together to support young people from diverse gender in the medical environment in a wide variety of ways, which normally do not involve any kind of procedural intervention. “
“There is a lot of concern about surgery or irreversible decisions,” when it comes to the health care that young transsexuals receive, added Wasserman, but surgery is not a component of that care.
The World Professional Association for Transgender Health declares in its Standards of Care for transgender adolescents that surgery “should not be performed until (i) patients reach the legal age of majority in a given country, and (ii) patients live continuously for up to at least 12 months on the gender role that is congruent with your gender identity. ”The standards add:“ The age limit should be seen as a minimum criterion and not an indication in itself for active intervention. ” The legal age of majority is at least 18 years in the USA
The Duke Health Gender and Child Care Center, for example, will offer children under the age of 16 therapies to delay puberty and provide hormone replacement therapy for those over 16.
“During this time, your child should meet with the local therapist weekly to control the emotional changes that happen during hormone therapy,” according to the clinic’s website.
Access to gender-based care also has a positive impact on the mental health of young transgender people. A study published in January 2020 found that trans people who used puberty blockers had lower rates of suicidal thoughts in adulthood compared to trans people who were unable to access them.
Rodrigo Heng-Lehtinen, deputy executive director of the National Center for Transgender Equality, said that Paul’s language was detrimental to Levine and all trans people who attended his audience.
“There is a lot of misinformation out there about health care for young transgender people in particular, but what is really important to know is that all the major medical institutions have researched this and really recognize that it is about primary care,” said Heng-Lehtinen. “It is different for every young trans, simply because any type of medical care is different for any type of individual patient, so it is personalized, but this is legitimate health care.”
Heng-Lehtinen cited the American Medical Association, the American Psychological Association and the American Academy of Pediatrics as medical organizations that support the rights of transgender teenagers to receive appropriate care with the support of providers and parents.
Advocates for LGBTQ rights quickly condemned Paul’s comments and praised Levine’s testimony.
“Although Rand Paul is a doctor, his own history makes it clear that he has no respect for science or medicine,” state deputy Brian Sims, a Democrat and Levine’s longtime ally, told NBC News.
Sims, who is gay and recently announced his candidacy for vice governor, called Levine “a world-class public health expert”.
“While I’m still excited about what Dr. Levine’s choice for President Biden means to her and the LGBTQ + communities, I’m even more excited about what it means for the country.”
Later, at Thursday’s hearings, Senator Patty Murray, D-Wash., Chairman of the Senate health committee, called Paul’s comments “ideological and damaging misrepresentations.”
But the American Principles Project, a conservative lobbying group that opposes gay marriage, transgender rights and abortion, defended Paul’s “immense courage” in challenging Levine.
“It is important that the American people are aware of how extreme Joe Biden’s nominees are and what they are likely to support as members of his administration,” said the group’s chief executive, Terry Schilling, in a statement. “Dr. Levine’s radical ideology should be a disqualifier for any position at HHS, let alone one as important as assistant secretary of health, and we urge the Senate to reject this confirmation when it is put to a vote. ”
Levine was recently Pennsylvania’s secretary of health and helped guide the community’s response to the coronavirus. She received high marks for staying in what The Pittsburgh Post-Gazette called “the calm in the center of Covid-19 storm”. She was, however, criticized for her policy of returning nursing home residents who had received treatment for Covid-19 in hospitals back to their facilities.
She is also aware of conservative transphobic attacks. For example, in a January 19 article about his appointment, the far-right Breitbart media made a mistake and repeatedly dubbed Levine. (Deadnaming refers to the use of a transgender person’s previous name.)
Shortly after the nomination, Pennsylvania state deputy Jeff Pyle posted a photo on Facebook mocking Levine’s appearance. After widespread criticism, Pyle, a Republican, deactivated his Facebook page and said he “had no idea” that the post “would … be received as badly as it was,” the Associated Press reported.
Levine is the first trans person to be nominated for a position confirmed by the Senate and “whenever you are the first trans person, a target is placed on your back,” said Heng-Lehtinen.
“My heart really is with her for having to endure these attacks, and I am grateful that she is as skilled at sailing as she is, but she shouldn’t have to do that,” he said. “For Senator Paul to let go of these myths and misconceptions about trans people and try to use that against them, I think it really shows how much the transphobia still exists. So, however historic it may be for a trans person to be able to stand before the Senate, and this is an important first step, but it also reveals how far we have to go ”.
Paul’s questions come at the end of a long week for LGBTQ advocates. The Chamber debated and passed the Equality Act on Thursday, and several states, including South Carolina and Utah, held hearings on bills that would prohibit transgender athletes from competing in school sports.
Nat Mulkey, a transgender medical student at Boston University who uses gender-neutral pronouns, said they had the privilege of moving away from the news “when it seems personally aggressive and harmful”, but not every trans person has it. Mulkey said that Paul’s language would negatively affect young transgender people.
“It is not hyperbole or exaggeration to say it is deadly,” said Mulkey of the senator’s language. They said that allowing trans youth to “have an authentic and private experience with their doctor to discuss these issues and not have invalidation at the national level is very important to promote their health and their lives in general”.
The Senate Health, Education, Labor and Pensions Committee must vote on whether to recommend Levine’s appointment to the full Senate. It is not yet known when this vote will take place.
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